| NPI | 1972897080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0821) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: UT 10105797-0501) |
| 213ER0200X Podiatrist, Radiology (Licence: UT 10105797-0501) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: UT 10105797-0501) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 10105797-0501) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2025-06-10 |